Provider Demographics
NPI:1982958773
Name:RETINA CARE PSC
Entity Type:Organization
Organization Name:RETINA CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANUELLI ANZALOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-680-7222
Mailing Address - Street 1:PO BOX 2770
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-2770
Mailing Address - Country:US
Mailing Address - Phone:787-680-7222
Mailing Address - Fax:787-680-7223
Practice Address - Street 1:58 CALLE PONCE DE LEON
Practice Address - Street 2:URB. GARCIA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4315
Practice Address - Country:US
Practice Address - Phone:787-680-7222
Practice Address - Fax:787-680-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLIC MD 16978OtherLIC MD